Citation NR: 9620579
Decision Date: 07/23/96 Archive Date: 08/02/96
DOCKET NO. 94-20 947 ) DATE
)
)
On appeal from the
Department of Veterans Affairs Regional Office in Boise,
Idaho
THE ISSUE
Entitlement to service connection for an acquired psychiatric
disorder.
REPRESENTATION
Appellant represented by: Disabled American Veterans
WITNESSES AT HEARING ON APPEAL
Appellant, Vet Center Representative
ATTORNEY FOR THE BOARD
L. Spear Ethridge, Associate Counsel
REMAND
The veteran had active duty from March 1969 to October 1969.
During the course of this appeal the veteran formally amended
the claim of entitlement to service connection for an
acquired psychiatric disorder, to include entitlement for
post-traumatic stress disorder (PTSD). In June 1991, the
claim for PTSD was withdrawn. At a personal hearing at the
regional office (RO) in November 1993, the veteran gave
testimony regarding symptomatology related to PTSD, and, in
essence, again raised the claim for PTSD. In a rating
decision dated in February 1995, the RO denied service
connection for PTSD because a definite diagnosis of PTSD was
not established pursuant to 38 C.F.R. § 3.304(f) (1995).
Service connection for an acquired psychiatric disorder was
originally denied in a rating decision dated in April 1991,
because the then current diagnosis, schizoaffective disorder,
was not shown in service. That rating decision has been
confirmed and remains in effect. In a statement dated in
June 1996, it appears that the representative argues for
entitlement to service connection for an acquired psychiatric
disorder, to include anxiety and PTSD. The representative
also requested that the case be referred to an independent
medical expert (IME).
Service medical records reveal that at an induction
examination in March 1969, the veteran indicated that he had
depression or excessive worry, and that he had nervous
trouble. The examiner elaborated that the veteran had no
psychiatric history. The corresponding medical examination
report did not indicate any psychiatric abnormality. July
and August 1969 record entries note the veteran was given
medication for nervousness. In September 1969, the veteran
was seen on several occasions for psychiatric complaints. On
September 13th, complaints of pressure building up and
uncontrollable crying were noted. On September 16th, it was
noted that the veteran had a passive-dependent personality
with a past history of drug abuse and a “character and
behavior background.” On September 20th, it was noted that
the veteran was not responding to counseling and medication,
and that he was recommended for an administrative action. It
was also recommended that he be put on “rear duty.” On
September 26th, a Report of a Psychiatric Examination
included a diagnosis of chronic severe passive-dependent
personality. It was noted therein that the veteran had
considerable anxiety during his first two weeks in the field,
and that his emotional response was stronger than that of
most of the new troops in the field. On a Medical Condition-
Physical Profile Record, dated on September 26th, the
diagnosis was noted as being moderate acute anxiety reaction.
On his discharge examination in October 1969, the veteran
indicated that he had soaking night sweats, frequent trouble
sleeping, frequent or terrifying nightmares, depression or
excessive worry, and nervous trouble. The corresponding
medical examination revealed that he had a chronic severe
passive dependent personality, and that the same diagnosis
was noted by a psychiatrist in September 1969. It was noted
that a recommendation was made for the veteran’s separation
from the military. On a Chronological Record of Medical Care,
dated in October 1969, it was noted that the veteran was
unable to perform his assigned duties because of his anxiety.
Acute anxiety reaction was noted in a Medical Condition-
Physical Profile Record dated in October 1969 that extended
the veteran’s duty limitation to November 1969
The most recent Department of Veterans Affairs (VA)
examination reveals that in January 1995, the examiner stated
that a diagnosis of PTSD was not warranted. It was
recommended that the veteran be hospitalized for a voluntary
psychiatric evaluation. The hospital evaluation indicates
that the diagnosis included Axis I acute stress disorder, in
remission, with a history of schizoaffective disorder, said
to be relatively stable, and alcohol and amphetamine
dependence, said to be in remission per the veteran. An
addendum to the VA examination indicated the same, and it was
noted that a number of psychiatric diagnoses were reported in
the past. It was reiterated that no evidence of PTSD was
found on the initial VA examination.
Psychiatric diagnoses reported in the past include a 1975 VA
hospitalization note, which indicated Axis I paranoid
schizophrenia, chronic type. A VA hospital record dated in
February 1990, indicated a diagnosis of Axis I chronic
undifferentiated schizophrenia and polysubstance dependence.
In a VA hospital record dated in September 1990, it was noted
that the veteran was evaluated on numerous occasions by the
psychiatrist on staff, and that there was difficulty in
differentiating between schizophrenia, chronic
undifferentiated, and the depressive phase of a bipolar
disorder. The Axis I diagnoses at that time included
probable PTSD and probable depressive phase of a bipolar
disorder. In a letter dated in June 1993, a Vet Center
counselor indicated that he was confused as to what the final
diagnosis should be, but that he believed that the veteran
had a pre-existing anxiety disorder in service, which was
aggravated by his exposure to combat, and that the veteran
may have had PTSD, an anxiety diagnosis. The Board of
Veterans’ Appeals (Board) observes that earlier psychiatric
treatment, apparently through a State agency, was reported in
the 1975 VA hospitalization record. However, the records are
not currently on file. The Board finds that this evidence
would be necessary and relevant for a full and fair
adjudication of the veteran’s claim. Robinette v. Brown,
8 Vet.App. 69 (1995).
It is unclear whether the veteran had an acquired psychiatric
disorder when he entered service, and if so, whether it was
aggravated in service, whether he had other than a
personality disorder at service separation, and whether any
current disorder is related to service, combat or otherwise.
Indeed, there has not been an medical opinion on this
relevant inquiry. A medical examination must specifically
address pertinent issues and the silence of an examiner
cannot be relied on as evidence against a claim. Wisch v.
Brown, 8 Vet.App. 139 (1995).
In view of the foregoing, the Board finds that further
evidentiary development is necessary before a decision on the
merits of this case can be rendered. Accordingly, to ensure
that the VA has met its duty to assist the veteran in
developing the facts pertinent to the claim and to ensure
full compliance with due process requirements, the case is
REMANDED to the RO for the following development:
1. The RO should obtain the names and
addresses of all medical care providers
who treated the veteran for a psychiatric
disorder at any time since service.
After securing the necessary release(s),
the RO should attempt to obtain all
records that have not previously been
obtained.
2. The veteran should be afforded a VA
psychiatric examination to determine the
relationship, if any, between any current
psychiatric disorder and his mental
health status in service. The report of
examination should include a detailed
account of all manifestations of
psychiatric pathology found to be
present. If there are different
psychiatric disorders, the psychiatrist
should reconcile the diagnoses and should
specify which symptoms are anxiety
related, which are psychotic
manifestations, etc. If certain
symptomatology cannot be disassociated
from one disorder or another, it should
be so specified. The examiner should
state whether any current symptomatology
is associated with and which disorders
are possibly related to complaints noted
in service in 1969, and whether any
psychiatric disorder that the veteran may
have had upon service entrance was
aggravated during that time. All
necessary special studies or tests
including psychological testing are to be
accomplished. The report of examination
should include complete rationale for all
opinions expressed. The claims folder
and a copy of this remand must be made
available to and reviewed by the examiner
during the course of the evaluation.
3. The RO should review the examination
report and determine if it is adequate
for rating purposes and in compliance
with this Remand. If not, it should be
returned for corrective action. The RO
should also undertake any additional
development indicated, including that
provided under 38 C.F.R. § 3.328 (1995).
4. After the development requested above
has been completed to the extent
possible, the RO should again review the
record. If the benefit sought on appeal
remains denied, the veteran and his
representative should be furnished a
supplemental statement of the case and
given the applicable time to respond
thereto.
Thereafter, the case should be returned to the Board, if in
order. The Board intimates no opinion as to the ultimate
outcome of this case. The veteran need take no action until
otherwise notified.
MARK J. SWIATEK
Acting Member, Board of Veterans' Appeals
The Board of Veterans' Appeals Administrative Procedures
Improvement Act, Pub. L. No. 103-271, § 6, 108 Stat. 740, 741
(1994), permits a proceeding instituted before the Board to
be assigned to an individual member of the Board for a
determination. This proceeding has been assigned to an
individual member of the Board.
Under 38 U.S.C.A. § 7252 (West 1991), only a decision of the
Board of Veterans' Appeals is appealable to the United States
Court of Veterans Appeals. This remand is in the nature of a
preliminary order and does not constitute a decision of the
Board on the merits of your appeal. 38 C.F.R. § 20.1100(b)
(1995).
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